Mentally Ill & Potential Violence

In September, 2008, 28 year old Isaac Zamora shot and killed a sheriff's deputy and five other people during a shooting rampage near his rural home and a high-speed chase along Interstate 5 in Alger, WA. He wounded two others. Over the past decade, he demonstrated increasing signs of serious mental illness, ranging from suicide attempts to auditory hallucinations. He was not taking his prescribed medication at the time of the homicides. Zamora had been diagnosed over the years with both bipolar disorder and schizophrenia.

Calls related to mentally ill subjects are some of the most troublesome and potentially violent calls officers respond to. In fact, 9% of all dispatch radio calls are related to mental illness. Tragic encounters between the mentally ill and law enforcement officers happen regularly, especially with schizophrenic and/or bipolar subjects not following a medication regime. People with mental illnesses commit police homicides at a rate 5.5 times greater than the general population.

Severe Mental Illness and Violence Facts

These statistics are from studies by the Treatment Advocacy Center

Approximately 1,500 homicides a year in the US are committed by individuals with severe psychiatric disorders.

There are approximately 4.5 million Americans with severe mental illness. Approximately 2.3 million are bipolar, and 2.2 million have schizophrenia. Of these individuals approximately 1.8 million are not be treated for their illnesses.

Law enforcement officers are more likely to be killed by a person with mental illness than by other assailants, including those who had a prior arrest for assaulting police or resisting arrest.

13% of in the line of duty officer deaths are related to mental illness.

A Department of Justice report found that: 12.3 % of defendants who kill their spouse, 15.8%, who kill their own child, 25.1% who kill their parents and 17.3% of siblings who kill a sibling have all had a history of untreated mental illness.

The risk of committing a homicide is about 10 times greater for schizophrenics of both genders than for the general population.

The risk is more than 17 times greater for men with schizophrenia and coexisting alcoholism.

One-third of the people killed by police showed signs of being emotionally disturbed or mentally ill at the time of the incident.

People with severe mental illnesses who ARE taking medication are no more likely to be dangerous than the general population.

People with mental illnesses are four times more likely than the general public to be killed by police in justifiable homicides.

People with mental illness are 3-4 times more likely to be victims of violent crime than the rest of the population.

Suicide is the number one cause of premature death among people with schizophrenia; an estimated 10%-13% kill themselves. Suicide is even more pervasive in individuals with bipolar disorder; an estimated 15%-17% percent will take their own lives.

Predicting Violence in Severely Mentally Ill Individuals

The three strongest predictors of violence for any subject a law enforcer encounters are:

a history of past violence

drug and alcohol abuse

a serious mental illness that is not being treated with medication.

The mentally ill subject most likely to become violent suffers from paranoid delusions, auditory hallucinations or both. A paranoid schizophrenic believes that others are out to harm him and a feeling that their mind is being controlled by outside forces or thoughts that are being placed in his/her head. At a crowded event a man may turn around and strike a child, believing he was just hit by laser beams which will render him sterile. Auditory hallucinations are a hallmark of psychosis. Command hallucinations, in which voices tell a psychotic individual what to do, is one of the most compelling predictors of violence.

A command hallucination is when a voice tells an individual to carry out a specific act(s). A person experiencing this kind of hallucination frequently feels under a powerful obligation to carry out such actions. The results are often devastating. Approximately 30% of schizophrenics have command hallucinations in which they feel compelled do what the voice tells them to do. Studies indicate that approximately 40% of these individuals report they have complied with such commands. Statistically, over 50% of command hallucinations are to commit suicide, 10% for homicide, and 10% for some other non-lethal injury.

Implications for Law Enforcement Officers

If the subject is in the act of attacking you, another, or himself, there is no question that you should respond with the appropriate level of force. However, if the situation is secure, and if no one can be accidentally harmed, you should adopt a non-threatening and non-confrontational stance with the subject. If you have access to a psychiatric crisis intervention team, have them respond to the scene.

Remove distractions and disruptive people from the scene. Understand that a rational conversation probably will not take place. One officer should try to establish rapport and speak with the subject. Speak simply and briefly. Give clear and firm directions. Do not give the subject multiple choices; this will only further confuse him or her. Ask about his/her delusions and hallucinations; but do not challenge them. Ask "Are you hearing voices?", "How many voices?", "What is the voice(s) telling you?", "What does the voice(s) want you to do?", "Do you believe you must do what the voice(s) is telling you?" Repeat these questions if you identify a change in the subject's behavior. Recognize and acknowledge that a person's delusional or hallucinatory experience is real to him or her.

Move slowly. Announce your actions before initiating them. Let the subject know that you are there to help; that you want to understand them. Your uniform, gun, handcuffs, etc. may be frightening to the subject; reassure them that you mean no harm. Do not maintain continuous eye contact. Except in situations in which the person must be physically detained, avoid any physical contact with the person. Do not crowd or surround the subject. Realize that his/her comfort zone may be much larger than that of other individuals. If the subject is acting dangerously but is not directly threatening to harm others or them self, allow the person to calm down. Have less-lethal force methods in place.

Once the situation is secure other officers should try to obtain as much information as possible from family or bystanders, especially related to psychiatric diagnosis, medication compliance, substance abuse and previous history of violence. Should this subject get psychiatric treatment at a behavioral health hospital or the county jail?

Once the subject is apprehended do not leave him alone in the patrol car, speak to him, or turn on music, as these methods may distract him from the voices. Inform the jail or hospital emergency department staff of the violence potential so that they can institute appropriate restraints.

Summary

The current mental health system will only provide treatment to the severely mentally ill once a person becomes dangerous to themselves/others or if they are gravely disabled. Police officers and sheriff's deputies have now been forced to become the front line mental health workers. Your job is to protect and serve, bottom line. Fortunately, related to officer safety, most acts of violence by the severely mentally ill are against family and friends, not you. However, 911 is the most frequently called phone number when there is violence; when there are voices. As first responders to these types of calls, it is crucial to remember that you, your partners, and others may very likely be in harm's way. Usually violence against officers by a severely mentally ill individual is related to the subject's misinterpretation of the officer's intent and a feeling of being cornered.